The Disputed Champion: Ampicillin and Gentamicin for Febrile Young Infants.

Abstract

The distribution of pathogens and approach to empirical antibiotics in febrile infants aged <90 days has been debated for decades. There is increasing disagreement as to whether the combination of those timeless workhorses ampicillin and gentamicin (A&G) remains appropriate empirical therapy given the changing epidemiology of bacteremia and meningitis in young infants.1–8 In the article by Feldman et al, researchers used the Pediatric Health Information System to describe regional differences in both pathogens and empirical antibiotic use in previously healthy infants <90 days old who were seen in 1 of 8 US pediatric children’s hospital emergency departments and had a positive urine, blood, or cerebral spinal fluid (CSF) culture.9 Not surprisingly, urinary tract isolates (urinary tract infection [UTI] alone or with associated bacteremia) made up 87% of infections. There was no regional difference in UTI pathogens. Blood and CSF pathogens differed by hospital, but susceptibilities remained constant and Escherichia coli and group B Streptococcus were the most common organisms. Third-generation cephalosporins (3GCs) were used for empirical therapy in the majority of infants, either alone (43%) or with ampicillin (39%). The combination of A&G was used in only 11% of infants. We struggle to understand why providers are not using A&G empirically in febrile infants <90 days of age. This choice flies in the face of data. In previous studies, researchers have consistently demonstrated equal, or in some cases superior, efficacy of A&G compared with 3GCs.3,10 In this study by Feldman et al, for example, A&G …